Our interdisciplinary research reflects a collaboration of academic and clinical organizations and personnel to refine existing pediatric health quality measures and develop new ones. Three key aspects of our proposal include: (1) the unique strength of our consortium (diverse pediatric healthcare organizations and clinicians, national healthcare stakeholder organizations, and academic partners with quality measurement expertise) to address the topics assigned by the Agency for Healthcare Research and Quality (AHRQ);(2) our experience and ability to work on diverse topics and measures;and (3) our capacity - by way of three examples - to manage measure development and implementation of measures proposed by the AHRQ. Specific Aims. The long-term goal of this project is to advance and improve children's healthcare quality measures that make a difference by both informing policy decisions and actual clinical performance in inpatient and ambulatory settings using proven methodologies. To achieve this broad goal, this proposal has four specific aims: 1. Forge new collaborations 2. Review existing measures and supporting data 3. Refine existing measures 4. Develop new measures Approach. Our approach is based on the time-tested American Medical Association - Physicians Consortium for Performance Improvement (AMA-PCPI) Roadmap for developing quality measures. To date, it has developed 270 measures across 43 clinical domains. More than 90 measures have been endorsed by the National Quality Forum (NQF). Many measures were noted in the proposed rule for meaningful use of electronic health records (EHRs), and it has enhanced some 40 measures with EHR specifications. Our 26 key project personnel from eight major national organizations will extend the AMA-PCPI Roadmap and apply it to measuring pediatric healthcare outcomes by following these steps. 1. Review evidence, gaps, data for impact 2. Measure development and enhancement 3. Measure specification 4. Measure testing 5. Measure and specification re-evaluation 6. National endorsement 7. Implementation 8. Feedback Three potential project examples demonstrate the robustness of the consortium, its capacity to respond to diverse topics and measures, and its proven ability in performance measurement and national implementation of measures. Outcomes. The following project outcomes will result. Our expanded approach will extract the necessary variables from EHRs to facilitate automated processing;implement quality measures and appropriate clinical and decision support (CDS) tools;integrate the ability to assess healthcare disparities;broaden the concept of access to care;leverage the Patient-Reported Outcomes Measurement Information System (PROMIS) item bank of patient reported outcomes and computer adaptive testing;expand evidence sources to include using quality improvement and collaborative learning;create a dashboard of measures that addresses current dimensions of quality across the continuum of care;forge new collaborations among relevant pediatric and perinatal stakeholders;and create a comprehensive testing network based on rich and multiple data sources. PUBLIC HEALTH RELEVANCE: The public health relevance of this project is to advance and improve children's healthcare quality measures that make a difference by both informing policy decisions and actual clinical performance in inpatient and ambulatory settings. This will be done by: 1) forging new collaborations;2) reviewing existing measures and supporting data;3) refining existing measures;and 4) developing new measures. Identifying these new and improved clinically relevant quality measures will facilitate the measurement and improvement of health status of children in the future.